The selection of a case of demonstrated change using a quantitative criterion preceded an exploration of possible change mechanisms in therapy. Between-session variations in the therapeutic relationship revealed by a quantitative measure prompted an intensive qualitative investigation of in-session events. Within these events, the study focused on challenges to the therapeutic relationship and their subsequent resolution. Understanding the resolution of such challenges to the relationship was guided by a rational model derived from the treatment rationale. A tentative account of the process of change is offered, and case replications are required to confirm and extend the findings.
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Agnew et al. (1994) studied this question.